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Major Changes Approved for How Recipients Are Selected From the Kidney Transplant List

You should be aware that the policy which dictates the guidelines for Kidney Transplant allocation has been changed. Previously, if someone needed a kidney transplant, it did not matter if s/he was 25 or 60 years old. What counted was how long s/he had waited on the list for a suitable kidney to become available. That has now changed! The objective is to make sure that the best kidneys will be given to those most likely to live the longest after their transplant, not necessarily those who have anxiously waited the longest on the list.

You should be aware that the policy which dictates the guidelines for Kidney Transplant allocation has been changed. Previously, if someone needed a kidney transplant, it did not matter if s/he was 25 or 60 years old. What counted was how long s/he had waited on the list for a suitable kidney to become available. That has now changed! The objective is to make sure that the best kidneys will be given to those most likely to live the longest after their transplant, not necessarily those who have anxiously waited the longest on the list.

This controversial policy change was made by the Organ Procurement and Transplantation Network (OPTN) on July 25, 2013 via its official website. The OPTN oversees all transplants in the U.S., and the United Network for Organ Sharing (UNOS), the nonprofit organization that manages organ donations in the U.S.

More than 93,000 people in the United States are on the waiting list for a kidney transplant, and the demand far exceeds the supply. While the old system was thought of as "fair" it did not strive to minimize death on the waiting list, nor maximize survival following transplant, UNOS says. In some cases, patients that received relatively poor kidneys were likely to live many years after their transplants, and later needed a second or third transplant from the already limited pool of kidney donations.

Under the new policy, kidneys would be given a score that reflects how long the organ is likely to keep working in its new owner. People needing transplants would also be given scores based on their age, years on dialysis and other factors that reflect how long they are likely to benefit from the transplant. But experts worry that older patients would be far less likely to get transplants now that this new plan has been adopted.

The new guidelines would require that the top 20 percent of kidneys would be offered to the top 20 percent of patients based on their score, according to UNOS. The remaining 80 percent of kidneys would be allocated in much the same way they were before. Children in the top 35 percent, however, will be prioritized to receive high-quality kidneys. Patients with very sensitive immune systems, who are extremely limited in the type of kidney they can receive, can also have priority over those with less-sensitive immune systems. Kidneys with low scores will be offered to patients in a wider geographic area than under the previous system, in order to increase the chances that those kidneys will be used rather than discarded. These changes are expected to result in more than 8,000 total extra years of life, among all patients receiving a kidney in a given year, UNOS says.

However, some experts say the effects of the changes will be marginal, and do not change the reality that the demands for organs is still far greater than the supply. It's not a major benefit because it only affects 20 percent of patients, said George Annas, chair of the Department of Health Law, Bioethics & Human Rights at Boston University School of Public Health. "Obviously, it's not going to solve the shortage of organs problem," Annas said.

This change is an attempt to maximize a valuable resource - kidneys - which is in short supply. But the question remains, "Is it fair to suggest that the life of a thirty-something has more value than the life of a fifty-something?" As Doctor Michael Abecassis, Chief of Organ Transplantation at Northwestern's Feinberg School of Medicine succinctly puts it, "How do you tell a 55-year-old: Too bad, you're too old, you're not getting a kidney because your life expectancy isn't that of a 35-year-old?"

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